Enoxaparin sodium is a low molecular weight heparin (LMWH) derived from porcine intestinal mucosa. It is an anticoagulant that acts by potentiating the inhibition of Factor Xa and thrombin (Factor IIa) by antithrombin III. The 40mg strength (equivalent to 4000 IU anti-Factor Xa activity) is primarily used for prophylaxis against deep vein thrombosis (DVT) and pulmonary embolism (PE) in medical and surgical patients, and for the treatment of acute coronary syndromes (ACS) in the Indian context.
Adult: **DVT/PE Prophylaxis (Surgical/Medical):** 40 mg (4000 IU) SC once daily, starting 2 hours pre-op (surgical) or at admission (medical). **ACS (Unstable Angina/NSTEMI):** 1 mg/kg SC every 12 hours (concomitant with aspirin). **STEMI (<75 years with thrombolytic):** 30 mg IV bolus followed by 1 mg/kg SC every 12 hours (max 100 mg for first two doses).
Note: For subcutaneous use only. Administer by deep SC injection into the abdominal wall, alternating sides. Use prefilled syringe. Do not expel air bubble. Pinch a skin fold between thumb and forefinger and insert needle at a 90-degree angle. Do not rub the injection site. Do not mix with other injections. Intramuscular injection is contraindicated.
Enoxaparin binds to and potentiates the activity of antithrombin III (AT-III), a natural inhibitor of coagulation enzymes. This binding causes a conformational change in AT-III, dramatically accelerating its rate of inhibition of activated coagulation Factor X (Xa). It has a higher ratio of anti-Factor Xa to anti-Factor IIa (thrombin) activity (approximately 3.8:1) compared to unfractionated heparin.
Pregnancy: **Category B (US FDA).** Does not cross the placental barrier in significant amounts. Considered a drug of choice for treatment and prophylaxis of VTE in pregnancy. Long-term use (>1 month) may be associated with osteoporosis. Requires specialist management.
Driving: No known effects on driving ability. However, dizziness reported as a side effect; patients should be cautioned.
| Oral Anticoagulants (Warfarin, Acenocoumarol) | Increased risk of bleeding. Monitor INR closely during overlap. | Major |
| Antiplatelet Agents (Aspirin, Clopidogrel, Ticagrelor) | Additive risk of bleeding, but often used together in ACS. Monitor for signs of bleeding. | Major |
| NSAIDs (Diclofenac, Ibuprofen, Naproxen) | Increased bleeding risk due to antiplatelet effect and GI irritation. | Moderate |
| Thrombolytics (Streptokinase, Alteplase) | Profound increase in bleeding risk. Used together in STEMI with specific protocols. | Major |
| Other Anticoagulants (Fondaparinux, Dabigatran) | Concomitant use is generally contraindicated due to excessive bleeding risk. | Major |
| Herbal Supplements (Ginkgo biloba, Garlic, Ginseng) | Potential increased bleeding risk. | Moderate |